Summaries of health policy coverage from major news organizations

Doctors from physician group Valley Heart Associates and the medical staff of Doctors Medical Center in Modesto have filed a defamation lawsuit in Stanislaus County Superior Court against Blue Cross of California, accusing the insurer of making "ghoulish and debasing" claims, the Modesto Bee reports (Carlson, Modesto Bee, 2/20). In October, Blue Cross released a review that said the hospital billed it for multiple medically unnecessary coronary bypass procedures. Blue Cross stopped authorizing payment for procedures at the hospital but later reinstated its authorization after Doctors tightened its internal oversight policies. In December, Tim Joslin, CEO of Doctors, filed suit against Blue Cross, accusing the insurer of libel and defamation (California Healthline, 11/24/03). The medical staff and doctors at Valley Heart, which performs about 90% of cardiac procedures at Doctors, say that the insurer's allegations in the report are false, adding that Blue Cross officials later repeated the accusations after admitting that they were false in a Nov. 17 meeting to discuss the review. According to the lawsuit, Dr. Ivan Kamil of Blue Cross said that the review was intended to be used to negotiate part of a payment dispute between the insurer and Doctors owner Tenet Healthcare. The Bee reports that one unnamed reviewer also said he was never asked to judge whether the surgeries were improper, only to recommend how he would treat each case, according to Mitchell Green, a lawyer representing the plaintiffs. The plaintiffs are seeking general and punitive damages from Blue Cross, its parent company WellPoint Health Networks, Blue Cross doctors Kamil and Woodrow Myers, Blue Cross spokesperson Michael Chee and Health Benchmarks, the firm hired to conduct the review.

Reaction

Green said that Blue Cross's allegations permanently harmed his clients' reputations, adding, "Blue Cross, in a matter of weeks, with access to the national press, was able to tarnish those reputations which are built up over a lifetime." He said, "We believe the damages are very significant, and we will leave it to a jury to decide (the monetary damages)." Green also said he will work to determine why Blue Cross targeted Doctors and its staff in its review. Chee said Thursday that he had not seen the lawsuit and could not comment (Modesto Bee, 2/20).

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